"Do not be anxious ... about your body." Assessing contemporary primary care in light of the Sermon on the Mount

Farr Curlin, MD, Duke University This presentation considers contemporary practices of primary care medicine in light of Jesus’ charge: Do not be anxious about your lives or your bodies. It is fashionable to champion prevention over cure. Who can argue? Yet, in the Sermon on the Mount, Jesus preaches:

“Therefore I tell you, do not be anxious about your life, what you will eat or what you will drink, nor about your body, what you will put on. Is not life more than food, and the body more than clothing? Look at the birds of the air: they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they? And which of you by being anxious can add a single hour to his span of life? And why are you anxious about clothing? Consider the lilies of the field, how they grow: they neither toil nor spin, yet I tell you, even Solomon in all his glory was not arrayed like one of these. But if God so clothes the grass of the field, which today is alive and tomorrow is thrown into the oven, will he not much more clothe you, O you of little faith? Therefore do not be anxious, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ For the Gentiles seek after all these things, and your heavenly Father knows that you need them all. But seek first the kingdom of God and his righteousness, and all these things will be added to you. Therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Sufficient for the day is its own trouble.”

Using illustrations from everyday clinical practice, the author proposes that much of contemporary primary care medicine either stirs up or is itself driven by anxiety about tomorrow. In the subsistence economy of first century Palestine, people worried about food and clothing; in the affluent economy of the 21st century West, people worry about health. No wonder, then, that 21st century medicine becomes a means for coping with anxiety. Rather than responding to the troubles that today has visited on patients, contemporary primary care medicine redirects the gazes of both patients’ and clinicians’ toward the troubles that tomorrow threatens. The power of the anxiety is measured in how much trouble patients and clinicians will go through to only very modestly decrease an individual’s risks of injury or death. Is going to such trouble consistent with Jesus’s exhortations? Are such practices consistent with trusting in a loving and all-powerful heavenly Father? The author will consider these questions and suggest that taking Jesus seriously might mean patients refusing to adhere with conventional medical recommendations and clinicians declining to concern themselves with conventional indicators of quality care. It may be that good medicine, at least for followers of Jesus, is medicine that entrusts the risks of tomorrow to a loving God, insisting that, “Sufficient for the day is its own trouble.”